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This version of the form is not currently in use and is provided for reference only. Download this version of
Form LS-201
for the current year.
Form LS-201 Notice of Employee's Injury or Death
What Is Form LS-201?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 1, 2009 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form LS-201?
A: Form LS-201 is a Notice of Employee's Injury or Death.
Q: What is the purpose of Form LS-201?
A: The purpose of Form LS-201 is to report an employee's injury or death.
Q: Who should fill out Form LS-201?
A: The employer or someone acting on behalf of the employer should fill out Form LS-201.
Q: When should Form LS-201 be filled out?
A: Form LS-201 should be filled out as soon as possible after an employee's injury or death.
Form Details:
- Released on April 1, 2009;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form LS-201 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form LS-201 Notice of Employee's Injury or Death
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